| NPI | 1598150161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q7489) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A134256) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2026-04-02 |